Froyshteter Alexander B, Bhalla Tarun, Tobias Joseph D, Cambier Gregory S, Mckee Christopher T
Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.
Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA.
Saudi J Anaesth. 2018 Apr-Jun;12(2):324-327. doi: 10.4103/sja.SJA_624_17.
Patients with Duchenne muscular dystrophy (DMD) often have systemic manifestations with comorbid involvement of the cardiac and respiratory systems that increase the risk of anesthetic and perioperative morbidity. These patients frequently develop progressive myocardial involvement with cardiomyopathy, depressed cardiac function, and arrhythmias. The latter may necessitate the placement of an automatic implantable cardioverter defibrillator (AICD) insertion. As a means of avoiding the need for general anesthesia and its inherent potential of morbidity, regional anesthesia may be used in specific cases. We present two cases of successful AICD insertion in patients with DMD using unilateral pectoralis and intercostal nerve blocks supplemented with intravenous sedation. Relevant anatomy for this regional anesthetic technique is reviewed and benefits of this anesthetic technique compared to general anesthesia are discussed.
杜氏肌营养不良症（DMD）患者常出现全身表现，心脏和呼吸系统合并受累，增加了麻醉和围手术期发病风险。这些患者常出现进行性心肌受累，伴有心肌病、心功能减退和心律失常。后者可能需要植入自动植入式心脏复律除颤器（AICD）。作为避免全身麻醉及其固有发病风险的一种方法，在特定情况下可使用区域麻醉。我们介绍了两例在DMD患者中成功植入AICD的病例，采用单侧胸肌和肋间神经阻滞并辅以静脉镇静。回顾了这种区域麻醉技术的相关解剖结构，并讨论了与全身麻醉相比这种麻醉技术的益处。
